PB2123: MANAGEMENT OF PATIENTS WITH CONCOMITANT LIVER CIRRHOSIS AND AGGRESSIVE LYMPHOMA – A LITERATURE REVIEW
Authors: J. Jelicic, T. Stauffer Larsen, A. Dam Fialla, B. Andjelic
Journal: HemaSphere (2022)

Background: Lymphoma and liver cirrhosis represent significant public health issues. The rising incidence of both diseases increases the risk of having cirrhosis as a comorbidity in a significant number of lymphoma patients. However, the management of such patients is challenging due to the lack of clear recommendations. Aims: This study aimed to summarize papers that analyzed patients with liver cirrhosis who were diagnosed with aggressive lymphoma. Methods: We performed a comprehensive literature search in PubMed and Embase among 1631 papers published between 2000 and January 2022. We used the following search terms: liver, cirrhosis, and lymphoma. Only articles that reported patients with liver cirrhosis as comorbidity and lymphoma with enough data on each patient were included in the study. Results: The final list consisted of 84 papers (case reports/series, abstracts, short communications). A total of 134 patients with liver cirrhosis and aggressive lymphoma were found. There were inconsistencies regarding available data across the studies. The median age of patients was 65 years (range 32-85 years) with a predomination of males (72, 65.5%). The most frequent cause of liver cirrhosis was hepatitis C infection diagnosed in 92 patients (68.6%), followed by hepatitis B infection (19 patients, 14.1%) and alcohol disease (12 patients, 8.9%), while other causes were less frequent. Decompensated liver cirrhosis (Child-Pugh B and C, ascites, jaundice, bleeding varices) was diagnosed in 35/76 patients (46.1%). Ann Arbor’s lymphoma stage was as follows: stage I/II had 34/75 patients (45.3%), III/IV had 41/75 (54.7%). B symptoms were present in 37/63 patients (58.7%). Standard immunochemotherapy (R)-CHOP/CHOP-like (Rituximab, cyclophosphamide, doxorubicin, oncovine, prednisone) was given to 58 patients (43.2%). Treatment modification and reduction (including palliative and less intensive treatment) were performed in 41/82 patients (50.0%), primarily due to liver disease (19/35 patients, 54.3%), while comorbidities and poor performance status were the cause of reduction in 9 patients (25.7%). Other causes were registered in 7 patients (20.1%). Side effects following treatment were recorded in 75 patients, including liver toxicity in 36 (48.0%) patients. Patients with decompensated liver cirrhosis received dose-reduced therapy more often than patients with compensated liver cirrhosis (72.7% vs. 27.3%, χ2=6.942, p=0.008, n=41). Complete and partial remission (CR/PR) was recorded in 48/64 patients (75.0%). Of 126 with known vital status, 63 were alive (50.0%). More deaths occurred among patients who received treatment reduction/modification than standard treatment (55.6% vs. 18.8%, χ2=9.72, p=0.002, n=68). The median survival was 25 months. Survival of patients with decompensated liver cirrhosis was significantly lower compared to patients without decompensation (5 months vs. median not reached, Log Rank=4.45, p=0.035). Patients who received reduced treatment had inferior survival (median 5 months) compared to patients treated with standard treatments (median not reached, Log Rank=7.150, p=0.007). Patients who did not achieve CR/PR had poorer survival than patients who achieved favorable treatment response (median 5 months vs. median not reached, Log Rank=42.69, p<0.0001). Summary/Conclusion: Due to liver disease, lymphoma patients tend to receive reduced/modified treatment regimes and have poorer outcomes. Management of patients with aggressive lymphoma and cirrhosis is challenging and requires a multidisciplinary approach.